Osteoclastic Giant Cells Research Articles

S1559 A Huge Surprise: Osteoclastic Giant Cell Tumor of the Pancreas

Introduction: Cystic lesions of the pancreas are often found incidentally on routine imaging. We describe an incidentally discovered pancreatic abnormality which was later confirmed to be a rare malignancy. Case Description/Methods: A 71-year old male with Warthin’s tumor and non-insulin dependent diabetes underwent computerized tomography (CT) of the soft tissues of the neck and the sinuses, incidentally demonstrating ground glass lung opacities. CT of the thorax then revealed sub-centimeter pulmonary nodules and an incidental 2.5 cm cystic mass at the pancreatic head, with biliary and pancreatic duct dilation. A pancreatic protocol CT confirmed a necrotic mass in the pancreatic head measuring approximately 3 cm, with pancreatic duct dilation up to 5 mm in the pancreatic neck. Scout EGD was unremarkable. Echoendoscopy was performed demonstrating a multi-cystic head of pancreas lesion measuring 2.8 cm x 2.8 cm, which was sampled with fine needle biopsy. Histology of the sample confirmed osteoclastic giant cell tumor, with immunohistochemistry showing cells positive for CD68, CD4, CD45, and vimentin, and negative for cytokeratin and pan-keratin. The patient underwent uncomplicated pancreaticoduodenectomy (Whipple’s procedure) with negative margins. The gross specimen (3.2 x 3.1 x 2.9 cm) confirmed undifferentiated carcinoma with osteoclast like giant cells. Discussion: Pancreatic adenocarcinoma is the most common type of pancreatic neoplasm, typically involving the pancreatic head. Pancreatic giant cell tumors (PGCT), officially termed “undifferentiated carcinoma with osteoclast-like giant cells) by the WHO, occur with an incidence of less than 1% of all pancreatic tumors. PGCTs rarely involve the pancreatic head, and typically occur in the body or tail of the pancreas. Typically occurring between the 6th and 7th decade of live, there is no preponderance between sexes. Three types are known: osteoclastic, pleomorphic, and mixed. Osteoclastic PGCT is thought to have the most favorable prognosis. Immunohistochemistry is critical in differentiating between osteoclastic and pleomorphic types, as pleomorphic GCT – typically positive for vimentin – are aggressive and more likely to metastasize. This patient did well with en-bloc surgical resection alone, though radiation therapy is sometimes offered depending on tumor size. In summary, we describe a rare pancreatic malignancy that was incidentally detected, diagnosed by EUS-FNB and successfully managed surgically.Figure 1.: a) CT pancreas demonstrating head of pancreas (HOP) lesion b) HOP mass on echoendoscopy c) gross specimen.

Assessment and management of undifferentiated carcinoma with osteoclastic like giant cells of the pancreas: a case report and revision of literature

BackgroundUndifferentiated carcinoma with osteoclast-like giant cells (UCOGCs) is a rare and aggressive non endocrine pancreatic carcinoma characterized by the presence of osteoclastic giant cells mixed with mononuclear cell. Very few cases have been reported in the literature and the histogenesis is controversial as, at the time of diagnosis, the tumor is often of advanced size and stage and it is difficult to pathologically observe its relationship with the pancreatic duct.Case presentationWe present a case of 65-year-old male patient presenting with abdominal pain, nausea, and weight loss, which was treated with surgical resection. Histological examination revealed an undifferentiated pancreatic carcinoma with osteoclast-like giant cells. The patient underwent to a routine pylorus preserving pancreatoduodenectomy. Actually, the patient was in good performance status and disease-free five months.ConclusionsBased on the present case and limited previous data, further researches preferably with large cohorts are necessary to clarify the pathogenesis of the neoplasm. However, as show in this case, histopathological and immunohistochemically studies are the gold standard for the diagnosis of UCPOGC. Investigation of the genomic alterations in UPOGCs could help to explain the histologic diversity of variant tumor and could provide a genetic basis for prognosis and treatment.

Fibro-osseous pseudotumor of the hand: a case report of a 22-year-old young woman

We present a case of a 22-year-old patient with an important expansive neoformation of the soft tissues near the proximal phalanx of the fourth finger of the right hand. There was no evidence of past direct traumas, wounds, or local infections. The Rx, CT scan and MRI exams showed a lesion of the soft tissues measured around 3 × 2 × 2.8 cm, without hinting at a connection with the bone structure with a hypointense signal in T1 and an isointense signal in T2. First diagnostic speculations pointed at a giant cell tumor of the tendon sheath (GCTTS). Since there seemed to be no indication of a malignant tumor, it was decided to execute an excisional biopsy on the patient, rather than an eco-guided core needle. The imaging studies of the histological characteristics showed spindle-shaped elements with low-grade atypia, fibromyxoid and osseous stroma in different maturity stages, and always delimited by osteoblast cells. Osteoclastic giant cells were also found, as well as foci of osseous metaplasia peripherally aligned around proliferating cell aggregates. Considering all the following data, the final diagnosis clearly indicated a fibro-osseous pseudotumor of digits (FOPD). At the last checkup after 6 months, the wound healed correctly and without any restriction in finger movement. Level of evidence: Level V, diagnostic study.

Osteoclastic giant cell variant of urothelial carcinoma in a COVID- positive patient: A rare variant in an unusual circumstances

Bladder carcinomas have a great propensity for divergent differentiation with more that 90% being Transitional cell carcinoma. Several histological variants have been have described so far; they are not only morphologically unique but also have significant prognostic and therapeutic differences making their timely identification of paramount importance. Osteoclastic giant cell variant of urothelial carcinoma is very rare type with controversial management. Studies from China have documented higher incidence and severity of illness in COVID-19 positive cancer patients. We report an unusual case of Osteoclastic giant cell variant of urothelial carcinoma in a 63 yrs old male patient associated with simultaneous COVID-19 infection.

Osteoclastic giant cell tumor of the pancreas with osteoid and bone formation: a case report

Background: Extraosseous giant cell tumors involving visceral organs (pancreas, kidneys, bladder, etc.) and soft tissues present similar histological features to those occurring in the bones. Rarely, they may affect pancreas and their origin remains still controversial, with some authors supporting the epithelial and some others the mesenchymal origin. Case Presentation: We report the case of a pancreatic giant cell tumor with osteoclast-like cells, negative for epithelial markers. A 64-year-old man presented with a 2-month history of progressively worsening abdominal pain, radiating to the lumbar region. He reported no other symptoms. The abdominal clinical examination was unremarkable and there was no associated jaundice. Liver function tests remained within normal limits. His past medical history had nil of note. He underwent an outpatient abdominal computed tomography which revealed a large cystic lesion at the body of the pancreas measuring 10 × 7 × 6.5 cm. We proceeded with a limited excision of the pancreatic mass alone, avoiding major dissections that would unnecessarily increase morbidity and mortality and the postoperative course was good. The histological morphological and immunohistochemical assessment revealed two tumor cell types: osteoclast-like multinucleated giant cells and pleomorphic mononuclear cells, with bone formation and without important cellular and nuclear atypia. Conclusion: Pancreatic giant cell tumors with osteoclast-like giant cells are rare tumors of the pancreas with various clinical characteristics and controversial origin. En bloc resection has prevailed as the only beneficial treatment so far.

MANAGEMENT OF ANEURYSMAL BONE CYST WITH BONE GRAFT AND TRICALCIUM PHOSPHATE WITH 6 YEARS OF FOLLOW UP: A CASE REPORT

Aneurysmal Bone Cyst (ABC) is a Benign tumor, Also known as Giant Cell Repetative Granuloma, They are locally destructive hemorrhagic benign cystic legion. According to the definition of the WHO Aneurismal Bone Cyst is expanding osteolytic lesion consisting of blood-filled spaces of variable size and that are separated by connective tissue septae containing trabecula of bone or osteoid tissue and osteoclast giant cells. We report a case of a giant aneurysmal bone cyst in the Middle one-third of Right humerus of a 16 -year-old boy, which was treated with Allograft, Autograft and ender's nail fixation. At 6 Years of follow up Patient regain a pain-free complete Range of motion with radiographically subside of legion.

Undifferentiated carcinoma of pancreas with osteoclastic giant cells along with PanIN in a diabetic female- a case report

Undifferentiated carcinoma of pancreas with osteoclastic giant cells is a rare tumor. The prognosis is slightly better than usual anaplastic carcinoma. It is said to have an epithelial origin. We present a case of 61-year-old female who presented with features of cholangitis and on evaluation found to have pancreatic mass. Pancreatic intraepithelial neoplasia was also present in our case, which is a feature less commonly noted in published literature.

Chondromesenchymal hamartomas in a 24-year-old male mimicking a posterior mediastinal tumor and a 5-month-old boy with postoperative disseminated intravascular coagulation: two case reports

BackgroundChondromesenchymal hamartoma of the chest wall is a rare, benign disease that usually presents at birth or in early infancy. It typically involves one or more ribs, forming a unilateral or bilateral extrapleural mass. Patients may be asymptomatic or complain of mild respiratory distress depending on tumor size and location. To the best of our knowledge, only two of the approximately 100 cases reported so far are adults.Case presentationWe present two cases of chondromesenchymal hamartoma. The first case involved the left fifth rib in a 24-year-old male, in close proximity to the fifth vertebral body in the left posterior mediastinum, mimicking a posterior mediastinal tumor on imaging. The tumor was excised via thoracoscopy and the patient had an uneventful postoperative course. The second case was that of a 5-month-old boy, who had a tumor involving the left fifth and sixth ribs which caused thoracic cage collapse. Following en bloc resection of the tumor and the involved rib segments, the patient was transferred to the intensive care unit for treatment of pulmonary infection and disseminated intravascular coagulation (DIC). He was discharged from the hospital in stable condition 11 days later. On histopathology, the tumor was found to be a chondromesenchymal hamartoma with immature spindle-shaped mesenchymal cells, plate-like hyaline cartilage, areas of woven bone formation, endochondral ossification and calcification, osteoclastic giant cells, and secondary aneurysmal bone cysts.ConclusionsAlthough the presently reported cases have morphological characteristics similar to previously reported ones, they had distinct radiological and clinical characteristics. Patient 1 is only the third report of an adult with chondromesenchymal hamartoma. His case was characterized by its radiological appearance mimicking a posterior mediastinal tumor. Patient 2 represents the first documentation of DIC as a postoperative complication following excision of a chondromesenchymal hamartoma. We present these two cases to provide clinicopathological insights regarding this extremely rare tumor that are relevant to both pathologists and clinicians.

Functional outcome in critical-size defect aneurysmal bone cyst of the distal humerus patient treated with curettage and nonvascularized autologous ibular graft

Aneurysmal bone cyst (ABC) is a rare benign expansive cystic lesion characterized by blood-filled cavernous spaces separated by septae containing osteoid tissue and osteoclast giant cells. Treatment goals are to stop progression of the lesion, relieve pain, stabilize pathologic fractures, and reduce recurrence rates. The standard of care for ABCs is curettage with or without bone graft depending on the resultant void. Despite best efforts at curettage, clinical series have shown highly variable recurrence rates, with some series showing rate ranges from 0% to 100%. Tumor resection may be associated with critical bone loss. Critical-size defects require reconstruction. Other than that, functional outcome after surgical treatment in patients with critical size defect is still a challenge even in benign tumor case. We reported a 32-year-old female presenting an entirely contained ABC to the distal metaphysis of the humerus treated with curettage and nonvascularized autologous fibular bone graft.

Management of aneurysmal bone cyst of proximal femur with a pathologic intertrochanteric femur fracture with an intramedullary nail and bone graft: A case report

Aneurysmal bone cyst (ABC) is a benign tumor like lesion that is an expanding osteolytic lesion consisting of blood-filled spaces of variable size separated by connective tissue septa containing trabeculae or osteoid tissue and osteoclast giant cells. Nearly 95% occur in the first three decades. Aneurysmal bone cysts are benign active or aggressive bone lesions that commonly arise in the metaphysis of long bones, especially the femur, tibia and humerus. They are extremely rare, occurring in 1.5 per one million people per year. And usually present with pain, swelling or fracture. We report a case of a giant aneurysmal bone cyst in the proximal femur with a pathologic Inter-trochentric femur fracture in a 23 year old male patient which was treated with a proximal femur nail and curettage and bone grafting of the lesion in the proximal femur. At 18 months follow-up, the lesion had subsided and patient was walking pain-free with full range of motion without any deformity. We suggest this method of treatment to be worthwhile for a pathologic fracture of an ABC at proximal femur.

Explanation for different behavior of peripheral and central giant cell granuloma by CD44 and CD34 immunostaining.

Despite their histopathological similarity, unlike peripheral giant cell granuloma (PGCG), central giant cell granuloma (CGCG) is an osteolytic lesion. Low motility of osteoclasts as bone-resorbing agents decreases osteolysis where CD44 plays a role. The lesion requires angiogenesis to grow which in turn may cause bone resorption. This study aims to compare CD44 and CD34 expression in PGCG and CGCG. 30 PGCG (group A) and 30 CGCG (group B) including non-aggressive (B1, N=14) and aggressive (B2, N=16) subgroups were evaluated for CD44 and CD34 expression through immunohistochemistry. CD44 staining intensity distribution (SID) score and CD44 labelling index (LI) in PGCG were significantly higher than those in CGCG, while microvessel density assessed by CD34 (MVD-CD34) was significantly higher in CGCG compared with PGCG. CD44-SID score and CD44-LI were higher for B1 whereas MVD-CD34 was higher for B2 (P<.05). Different CD44 expression among the studied groups may be indicative of the different motility of osteoclastic giant cells which may influence bone resorption. Lower CD44 expression probably indicates higher osteoclastic giant cell motility in CGCG, which with its higher angiogenesis may explain the different clinical behavior of CGCG compared with that of PGCG.

Clinicopathological study of undifferentiated pancreatic carcinoma with osteoclastic giant cells

目的 探讨伴有破骨样巨细胞的胰腺未分化癌（UCOGCP）的临床病理学特征、鉴别诊断要点及预后。 方法 收集并观察6例UCOGCP临床组织形态学特点及免疫组织化学结果，3例肿瘤组织Sanger测序法检测KRAS基因的突变状态，复习相关文献进行分析。 结果 患者男性3例，女性3例，发病年龄范围40至77岁（中位年龄58岁），3例肿瘤位于胰头部、3例位于胰体尾部。肿瘤最大径2.0~5.8 cm，大体表现为实性或囊实性占位，切面灰白质硬，部分病例可见囊性出血坏死区。镜下肿瘤特征性的由两种细胞成分组成，一种为体积较大、形态温和的破骨样巨细胞；另一种为单核异型肿瘤细胞，核异型性显著伴异染色质；核分裂象活跃，可见病理性核分裂象；肿瘤组织间质出血常见。2例肿瘤合并普通型导管腺癌成分。免疫组织化学：破骨样多核巨细胞表达CD68、波形蛋白、白细胞共同抗原，Ki-67阳性指数低；单核异型细胞表达波形蛋白、p16、p53，Ki-67阳性指数高；4例单核异型细胞表达至少一项上皮标志物。3例病例行分子病理检测KRAS基因的第2、3号外显子，显示有KRAS基因点突变。 结论 UCOGCP是一种罕见的胰腺未分化癌组织学亚型，组织形态学方面类似骨与软组织的恶性巨细胞瘤，结合免疫组织化学检查有助于诊断与鉴别诊断，KRAS基因检测亦可作为重要的辅助诊断手段。

Undifferentiated carcinoma of pancreas with osteoclastic giant cells: a case report

Undifferentiated carcinoma of pancreas with osteoclastic giant cells: a case report

Uterine pleomorphic leiomyosarcoma with osteoclastic giant cells: Case report with peritoneal washing cytology and cell block study

Uterine leiomyosarcoma (LMS) with osteoclastic giant cells (OGCs) is extremely rare. However, its morphological appearance and aggressive behavior may have resulted in its being diagnosed as so-called giant cell malignant fibrous histiocytoma (MFH) in the past. Effusions are not uncommon in LMS and may be indicative of an unfavorable prognosis. We report a case with the cytological appearance of a uterine LMS with OGCs metastatic to lower pelvic peritoneum. The pelvic washing specimen consisted of three-dimensional aggregates of atypical cells. The cytohistologic and immunohistochemical study obtained from the cell block and the tumor mass showed overlapping features such as bizarre pleomorphic spindle cells containing numerous evenly dispersed OGCs. The malignant tumor cells showed extensive positivity for desmin, h-caldesmon and multifocal positivity for smooth muscle actin (SMA) whereas OGCs stained with CD68. We stress the usefulness of performing cell block and subsequent immunohistochemistry in order to make an accurate cytohistologic correlation.

Osteoclastic giant cell tumour of the pancreas: A case report

Background: Pancreatic giant cell tumours are rare with an incidence of less than 1% of all pancreatic tumours. Although the World Health Organization has now recognised a variant of undifferentiated carcinoma with osteoclast-like giant cells, a benign appearing osteoclastic giant cell tumour of the pancreas is rarely described.

Giant malignant fibrous histiocytoma of the testis.

We present a case of malignant fibrous histiocytoma of the testis in a 59 year- old male who admitted to our hospital with left testicular painless mass presenting for two months. A scrotal ultrasound examination and magnetic resonance imaging revealed a 9 cm left testicular solid mass. Serum tumor markers were unremarkable. The patient underwent left radical orchiectomy. Histopathologic diagnosis was giant cell variant of malignant fibrous histiocytoma which composed of varying amounts of a mixture of spindled, rounded and osteoclastic type giant cells. Hemorrhagic and necrotic areas were seen between tumor nodules. In immunohystochemical staining, vimentin, CD68 were positive and SMA was focally positive. The patient then received adjuvant chemoterapy and currently, he has no sign of recurrence.

Combined Effects of Simulated Microgravity and Radiation Exposure on Osteoclast Cell Fusion.

The loss of bone mass and alteration in bone physiology during space flight are one of the major health risks for astronauts. Although the lack of weight bearing in microgravity is considered a risk factor for bone loss and possible osteoporosis, organisms living in space are also exposed to cosmic radiation and other environmental stress factors. As such, it is still unclear as to whether and by how much radiation exposure contributes to bone loss during space travel, and whether the effects of microgravity and radiation exposure are additive or synergistic. Bone is continuously renewed through the resorption of old bone by osteoclast cells and the formation of new bone by osteoblast cells. In this study, we investigated the combined effects of microgravity and radiation by evaluating the maturation of a hematopoietic cell line to mature osteoclasts. RAW 264.7 monocyte/macrophage cells were cultured in rotating wall vessels that simulate microgravity on the ground. Cells under static 1g or simulated microgravity were exposed to γ rays of varying doses, and then cultured in receptor activator of nuclear factor-κB ligand (RANKL) for the formation of osteoclast giant multinucleated cells (GMCs) and for gene expression analysis. Results of the study showed that radiation alone at doses as low as 0.1 Gy may stimulate osteoclast cell fusion as assessed by GMCs and the expression of signature genes such as tartrate resistant acid phosphatase (Trap) and dendritic cell-specific transmembrane protein (Dcstamp). However, osteoclast cell fusion decreased for doses greater than 0.5 Gy. In comparison to radiation exposure, simulated microgravity induced higher levels of cell fusion, and the effects of these two environmental factors appeared additive. Interestingly, the microgravity effect on osteoclast stimulatory transmembrane protein (Ocstamp) and Dcstamp expressions was significantly higher than the radiation effect, suggesting that radiation may not increase the synthesis of adhesion molecules as much as microgravity.

Vascular Invasion in Undifferentiated Pancreatic Carcinoma With Osteoclastic Giant Cells: An Atypical Case of a Rare Malignancy

Vascular Invasion in Undifferentiated Pancreatic Carcinoma With Osteoclastic Giant Cells: An Atypical Case of a Rare Malignancy

Ampullary adenocarcinoma with osteoclast giant cells

Ampullary adenocarcinoma with osteoclast giant cells

Hemipelvectomia total em um gato com osteossarcoma osteoblástico

Background: Osteosarcoma (OSA) is a malignant neoplasm of mesenchymal tissue that exhibits various histological features and a differentiated biological clinical behavior. The combination of clinical, radiological, and histopathological features is important for diagnosis. Surgical treatment of neoplasms with pelvic involvement is a challenge. Primary bone tumors are rare in cats and are mostly reported in older animals. The objective of this paper was to report the case of a feline subjected to total hemipelvectomy as primary treatment of pelvic OSA; the surgical technique and histological analysis of the tumor are described. No signs of recurrence were seen during seven months of follow-up.Case: A 4-year-old female mixed breed cat weighing 3 kg was presented with a one year history of increased volume on the hip joint region. Palpation of the increased volume on the hip showed a firm, adhered, and painful mass. Radiographic examination of the pelvis in the dorso ventral projection exhibited a severe osteoblastic bone reaction on the proximal femur, as well as marked periosteal reaction of the hip joint with involvement of the acetabulum. A ventral approach total hemipelvectomy technique was adopted for excision of the tumor. The animal was placed on a lateral position and a circumferential skin incision was performed on the ipsilateral limb of the affected hemipelvis, on the medial portion of the femur, and was extended cranially up to the thoracolumbar region. The pubic symphysis was exposed with a periosteal elevator and a pubic symphysiotomy was performed on the midline using a Liston bone cutter; next, the sacroiliac junction was resected. No drain was used after surgery, only compressive bandages. The patient was hospitalized for post-operative monitoring which included opioids for pain management and a non-steroidal anti-inflammatory drug and a cephalosporin class antibiotic. The wound was cleaned with saline, rifamycin spray (Rifocina Spray®) was applied, and dressing was changed every 12 h. The excised bone was submitted for pathological analysis. Gross examination revealed a 4.2 cm hardened increase in volume on the area of the femoral head and acetabulum, with irregular surface; cut surface was hard and white with black and red spots. Histology revealed osteoblastic OSA with intense and solid fusiform and stellate cells distributed in a solid pattern with no capsular border, with marked infiltration of the bone tissue, marked osteolysis, moderate proliferation of osteoclasts, and moderate anisocytosis and anisokaryosis.Discussion: Bone tumors in cats are rare and develop spontaneously. They exhibit aggressive behavior and promote local bone destruction. Firm consistency and local swelling usually occur in more advanced cases when there is a delay between the onset of clinical signs and the veterinary consultation. Radiological findings such as bone destruction and bone formation are commonly seen in this type of tumor. Hemipelvectomy is considered an aggressive surgical technique, but necessary in many cases, especially when tumors are located in the pelvis and nearby tissues. In the case presented here, this surgery was the most viable and advised therapeutic option because of tumor location. No incidents (i.e. hemorrhage) occurred during the perioperative period. After surgery, the patient continued to perform all custom functions. The hind limb, which was affected in this case, is commonly reported to be affected in the literature; however, it is unusual to have involvement of both bones (pelvis and femur) since vascularization of these bones are independent. Diagnosis was confirmed by histopathology in which a characteristic malignant mesenchymal tumor of primitive bone cells was present, with production of osteoid of variable shapes and quantity with the presence of osteoclastic giant cells.